Comparison of Manual Vacuum Aspiration and Misoprostol in the Management of Incomplete Abortion

Background: Incomplete abortions can be managed expectantly; surgically and medically (using misoprostol). Expectant management is safe in places where women have access to information; appropriate care and follow-up; however; in isolated and poor areas women who come for help need an intervention.Objective: To compare the efficiency of manual vacuum aspiration (MVA) and misoprostol in the treatment of incomplete abortion.Patients and method: This was a prospective study over five months from March to August 2015. All patients admitted with a diagnosis of incomplete abortion were recruited into the study.Results: 308 patients with incomplete abortion were randomized into two treatment groups - MVA (done under local anaesthesia) and misoprostol (400 micrograms by the vaginal route). MVA was successfully performed for all patients. Two patients presented with anaemia. In the misoprostol group; 23 patients had vaginal bleeding; and 10 persistence of incomplete abortion. Conclusion: MVA is more effective than misoprostol with less complications in the treatment of incomplete abortion when it is done by a trained person

Complications attributed to illicit abortions

A four year prospective study was carried out involving 83 cases of induced abortions, 72 were induced illegally and 11 were medically indicated, to determine the incidence and types of complications of illegally induced abortions as well as those of therapeutic ones. The prevalence of illegal abortion was 3.61% and that of therapeutic was 0.55%. In illegally induced group, age of 48 [66.66%] women ranged between 21-35 years, 34 [47.22%] were grand multiparas and 79% were illiterate. In 31 [43.25%] women, illegal abortions were carried out by TBAs and the most commonly used method was instrumentation employed in 46 [63.88%] of cases. The commonest complication detected was haemorrhage occurred in 31 [43.25%] patients, followed by sepsis in 24 [33.33%] and trauma in 13 [18%] cases. Indications of therapeutic abortions included maternal malignant diseases and fetal anomalies. Only one patient developed post abortal endometritis

Rubella Antibodies in women with history of recent abortion

A study was designed to detect the prevalence of rubella antibodies and assess the immune status of 75 women of different age groups with a history of present abortion. Quantitative analysis of anti-rubella IgG and IgM was done on the sera. These cases were selected from a total number of 275 pregnant women presenting to the Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre, from July, 1991 to April, 1992. A solid phase enzyme immunoassay [ELISA] was used for this purpose. Out of these 75 cases, 70 [93.3%] were positive for IgG while only 2 [2.7%] were positive for IgM antibody. Three out of 75 [4%] were negative for both IgG and IgM

Les complications du post-abortum en milieu gyneco-obstetrical de l'Hopital Central des Armees Pierre MOBENGO: a propos de 250 cas colliges de 1985 a 1987. [Resume]

Les auteurs rapportent 250 cas d'avortements provoques recenses de 1985 a 1987 dans le service de Gyneco-Obstetrique de l'Hopital Central des Armees Pierre MOBENGO. Ils ont selectionne 668 cas d'avortement dont 418 spontanes et 250 provoques clandestins; seuls ces derniers ont fait l'objet de cette enquete. Celle-ci concerne l'avortement clandestin pratique par un personnel non medical; mais aussi par des infirmiers et malheureusement quelques mededecins inexperimentes et les patientes elles-memes. Les statistiques hospitalieres ne semblent pas du tout refleter la realite; car de nombreux cas d'avortements provoques n'ont pas ete declares comme tels a cause des poursuites civiles et judiciaires possibles. L'analyse de la situation des patientes admises pour ce motif rapporte les resultats suivants: Les avortements clandestins constituent un motif de consultaion a l'Hopital Central des Armees; et representent le quart des hospitalisations du service de Gynecologie; les tranches d'age les plus concernees sont celles comprises entre 19 et 23 ans et de 24 et 28 ans; les moyens abortifs utilises par la majorite des patientes sont mecaniques et medicamentaux. la guerison se fait aux prix de nombreuses sequelles psycho-organiques: la moitie de ces patientes consultent ulterieurement pour sterilite secondaire; troubles du cycle; et troubles de la personnalite

role of repetitive human chorionic gonadotropin supplementation in decreasing early pregnancy wastage

Eighty women in their early pregnancy [5th week] were divided into two equal groups, the first group received 3000 I.U. human chorionic gonadotropin [HCG] intramuscularly twice/week from the 5th till 8th week of pregnancy while the second group received no HCG treatment. Each group was further divided equally into 2 subgroups each of 20 patients. The patients in the first subgroup were those who conceived after clomiphene citrate [CC] treatment for induction of ovulation. Those in the second subgroup were the patients who conceived spontaneously and with a past history of early abortions. In the HCG treated group, 6 out of 40 patients aborted [15%] compared to 16 out of 40 patients [40%] in those who were not treated with HCG [P <0.01]. HCG supplementation during early pregnancy decreased the percentage of pregnancy wastage from 45% in 15% in patients who conceived on CC or CC/HCG induction of ovulation [P <0.01]. Also, HCG treatment decreased pregnancy wastage% from 35% to 15% in patients who conceived spontaneously and having a history of previous abortions [P <0.01]

Diagnostic tests for toxoplasmosis in women having history of fetal wastage

One hundred pregnant patients having history of fetal wastage and 20 pregnant women with no history of fetal wastage as control, were serologically examined for the total toxoplasma specific antibody titer using the direct agglutination test. Those who had significant high antibody titer were re-examined for anti-toxoplasma IgM antibodies using the IgM microassay. It was found that among the selected cases 42% were seropositive for the total toxoplasma specific antibody titer, while 25% were seropositive among the control group. This was statistically insignificant. On the other h and, 25% of the selected cases were seropositive for the anti-toxoplasma IgM antibody titer, while 10% of the control group were seropositive. This was also statistically insignificant

Acute abdomen a complication of uterine intervention

A prospective evaluation of 19 patients of complicated abortion presenting in the general surgical emergency over a period of four and a half years is presented. The mean age of the patients was 25.4 years. Presenting complaints included acute abdominal pain, vomiting, abdominal distension and absolute constipation in all cases. 16 patients were married and 3 unmarried. Tachycardia, pyrexia, generalised abdominal tenderness, guarding and absent bowel sound were present in all cases. Free gas under the diaphragm was present in 11 patients and multiple air fluid level in 8 patients. 13 out of 19 patients had intestinal injury [10 small gut and 3 colon]. 7 patients had external evidence of intestinal injury. Fundus of the uterus and posterior fornix were the common sites of perforations. Fundal perforations were repaired. Hysterectomy was carried out when the perforation involved the fornixes and major vessels and in those patients who pre-operatively asked for it. In six patients resection and anastomosis for small gut injury was carried out where as in four patients perforations were repaired. In 3 patients with colonic injury, resections and anastomosis of the injured colon along with transverse colostomy were carried out. There were two deaths in this series. The incidence of post operative complications was low. Mean hospital stay remained 8 days. Emergency surgeon dealing with general surgical emergencies should keep this possibility in mind if patient gives history of D and C and features of acute abdomen